AccountId: 011433970860
ContactId: 6d4e0356-8378-4456-a00e-84474709ed3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 348160 ms
Total Talk Time (AGENT): 91864 ms
Total Talk Time (CUSTOMER): 77889 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/6d4e0356-8378-4456-a00e-84474709ed3f_20250416T18:19_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi, this is [PII].
[CUSTOMER][NEUTRAL] Yes, hi, good afternoon. I'm calling to see if a patient's plan covers office visit specialist copay.
[AGENT][NEUTRAL] OK. Office visits, specialists and co-pays?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] I do. It is 0163.
[CUSTOMER][NEUTRAL] 7396 M for Michael, L for Larry, and the number 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] Perfect. And then the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, so it looks like the outpatient benefit max per calendar year is $1000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] For office, they have an office treatment writer.
[AGENT][NEUTRAL] And let me look into their policy and see what that covers.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] OK, so it seems like their office treatment writer they have follows the outpatient benefit max, which is the one I quoted, the 1000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It just means that office visits may be covered under the outpatient benefit amounts.
[CUSTOMER][NEUTRAL] So it's not.
[CUSTOMER][NEUTRAL] So we don't know.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, it's not a guarantee of payment, it's just a verification of coverage.
[CUSTOMER][NEUTRAL] Right, but you said it's $1000 per person, has $1000 been used to like.
[AGENT][NEUTRAL] Let me see if it's been used really quick.
[CUSTOMER][NEUTRAL] [PII], what's wrong?
[CUSTOMER][NEUTRAL] At the same time
[CUSTOMER][NEUTRAL] Yeah, she wants to make sure.
[CUSTOMER][NEUTRAL] Yeah, that's fine. What else? I, and I need to figure out what's going on with D also.
[AGENT][NEUTRAL] OK, so it doesn't
[CUSTOMER][NEUTRAL] Go where?
[CUSTOMER][NEUTRAL] Sorry, go ahead, sorry, I was having a different conversation, go ahead.
[AGENT][NEUTRAL] No, no, you're OK, um, so it doesn't look like anything's been used this year.
[CUSTOMER][NEUTRAL] OK, so what, so she has, does that mean you guys cover the copay?
[AGENT][NEUTRAL] No, so with our insurance, we do not cover copays. We, uh, it's just the benefit amount that I gave you, the outpatient.
[CUSTOMER][NEGATIVE] So it does not cover copays.
[CUSTOMER][NEUTRAL] OK, can I get a reference number for this call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. It's my first name, which is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Last initial [PII] and then it would be today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And that's for [PII]. OK, perfect, thank you so much I appreciate it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, you're welcome. Thanks for calling APL. Have a good day. Mhm. Bye bye.
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][POSITIVE] You too thanks bye.